PADI and SDI Rescue Scenerio differences

[Adam Grose]

If you are worried about doing the exact right thing in this circumstance....

I have many, many times issued this challenge: identify a case in which divers have come across an unresponsive diver underwater, brought the victim to the surface, called for help, begun rescue breaths, towed the diver to shore or boat while giving rescue breaths, removed the divers gear while giving rescue breaths, removed the rescuer's gear while giving rescue breaths, brought the diver to a hard surface, begun CPR, and had the victim survive.

I am still awaiting my first successful scenario.

That may be true, but I would rather at least TRY to save someone's life that just stand by doing nothing. If I do nothing, they probably WILL die. If I try to save someone's life and fail, I will have a MUCH easier time living with myself, then if I did nothing and let them die.

Adam

 

[Colliam7]

Simon, thanks, that is a good perspective, to which I hadn't given sufficient attention in my post.

And, I fully agree, that 'rescue breaths (breaths as early as it is physically possible to administer them) may be the key life saving intervention in drowning'.

I have no data available to suggest that the initiating event in an unresponsive, non-breathing subject on the surface or underwater is reliably asphyxia / drowning. A cardiac event underwater or on the surface is just that - a cardiac event. But, I readily acknowledge that the likelihood of an asphyxia / drowning etiology in a subject found unresponsive underwater or even on the surface has to be given much more attention than in the subject who collapses on land, and is found unresponsive and not breathing.

 

[Dr Simon Mitchell]

If you are worried about doing the exact right thing in this circumstance....

I have many, many times issued this challenge: identify a case in which divers have come across an unresponsive diver underwater, brought the victim to the surface, called for help, begun rescue breaths, towed the diver to shore or boat while giving rescue breaths, removed the divers gear while giving rescue breaths, removed the rescuer's gear while giving rescue breaths, brought the diver to a hard surface, begun CPR, and had the victim survive.

I am still awaiting my first successful scenario.

Hi John,

Maybe not a purple cow but a magenta one.

I get the point of your question, but I think it is a little unfair. The survival rate in cardiac arrest in the community is abysmal, even when emergency services get there fairly quickly. With this in mind, good outcomes are going to be extremely hard to come by in the even more dangerous setting of arresting underwater when things get complicated by water aspiration.

I think the more appropriate question would be how often have we seen good outcomes at some point along the chain of actions that you articulate in your challenge? The picture is a little brighter there. There have been a number of rescues where an unresponsive diver has been brought to the surface and initiation of rescue breaths has stimulated return of spontaneous breathing (meaning that the diver was not in full arrest). I have witnessed two such events myself and in one the return of breathing did not occur until full CPR was initiated which is close to your scenario (though I don't believe the diver could have been in full cardiac arrest because CPR of itself is unlikely to fix that). In both cases the loss of responsiveness was witnessed (but they were not seizures - there have been a number of successful rescues from those also).

In addition, there is at least some circumstantial evidence from the surf lifesaving literature that spectacular recoveries (even from full arrest) are possible. The obvious difference is that in the surf lifesaving setting the loss of responsiveness is always effectively "witnessed" or close to it, there is no need to rescue from depth, and the victim is rescued to an environment where reasonable resuscitation care can be provided quickly. Nevertheless, some of these factors are replicated in certain diving settings, and the bigger experience base in surf lifesaving allows us to conclude that successful rescue is at least plausible. I have uploaded a fascinating and unique paper that speaks to some of these points, and for interest, to the point that in water rescue breaths are a good idea.

Simon M

 

[Bubblesong]

If I have either hypoxia OR cardiac arrest, either way I am going to closely resemble that purple cow, so please hurry up with the breaths!

 

[Kevrumbo]

. . . The survival rate in cardiac arrest in the community is abysmal, even when emergency services get there fairly quickly. With this in mind, good outcomes are going to be extremely hard to come by in the even more dangerous setting of arresting underwater when things get complicated by water aspiration. . .

Simon M

The nightmare Chamber Crew scenario here at the Catalina Hyperbaric Facility, is a diving casualty in full cardio-respiratory arrest, R/O AGE & near Drowning, and performing CPR on this patient while the Chamber is being pressurized to 165ft /50m (6ATA) for a Table 6A Treatment --the heat of compression is well over 95deg F/35deg C (imagine being inside your Scuba tank during a fast fill)-- you're equalizing your ears, narc'd out-of-your-mind and laboring with CPR chest compressions to near exhaustion in the noise and heat trying to save this person's life. . .

The Paramedics inside the Chamber provide Advanced Life Support, but they and the Chamber Crew can only use manual CPR and Bag Valve Mask Ventilation -no aiding cardiac defibrillator unit is allowed inside because of the extreme fire hazard of electrostatic discharge in a hyperbaric oxygen environment.

You have to continue working it as a team alongside LA County Paramedic-Lifeguards until the victim regains vital signs (unfortunately at this point, not very likely), or the Emergency/Hyperbaric Physician arriving by helicopter from the mainland some 30min later, goes down in the auxiliary transfer Lock to 6 ATA, and examines & declares the patient dead.

If I have either hypoxia OR cardiac arrest, either way I am going to closely resemble that purple cow, so please hurry up with the breaths!

Here is a harrowing and heart warming 1st person account (a successful @boulderjohn "purple cow" case) of an actual LA County Lifeguard who survived a critical dive accident himself (with complicating water aspiration and secondary developing Pulmonary Edema), and later "paid it forward" by donating a kidney to a friend who needed a transplant: